Introduction: Medical education requires participation of variousstakeholders and this contributes to power dynamics operating atmultiple levels. Personality traits of an individual can affect thesmooth execution of the educational programmes and eventuallythe professionalism of the environment. With the increased focuson leadership traits in medical education and collaboration inhealth care settings, I, through this commentary, would like toexplore the Machiavellian power dynamics involved and how itcan influence the harmony prevailing in an organization.Methods: The author has tried to review the several aspects ofMachiavellianism in health care settings and describe day-to-dayexperiences at four levels; micro (individual), meso (departmental),macro (institutional) and mega (discipline). Introspecting on theunaddressed issues in a different light would help to gain a deeperunderstanding regarding work place ethics and professionalism.Results: The reflection of day-to-day experiences in a differentperspective would provide an insight regarding various issuesto health professionals and help in developing ethical leadershipabilities in them, which eventually promulgates professionalism.Conclusion: To my best knowledge, this is the first commentaryto deal with the implications of Machiavellianism in differentissues related to health care settings. With the increased emphasison the leadership traits related to medical education, analysingorganizational issues in various dimensions is of paramountimportance.Keywords: Leadership, Machiavellianism, Professionalism, Organizational dynamics